Individuals with symptoms of cardiovascular disease or who are over the age of 40 years and have Type 1 or Type 2 diabetes should be considered at high risk (>= 30% risk over 10 years) of cardiovascular events.
- Diabetic patients with angina should be managed in accordance with the NHSGGC guideline for the management of angina. Diabetic patients with new-onset chest pain suggestive of coronary heart disease should be referred for fast track chest pain assessment in accordance with this guideline.
- Beta-blocker therapy (or a rate-limiting calcium channel blocker, long-acting nitrate or nicorandil in those intolerant of beta-blockers) should be commenced for first line symptomatic treatment in accordance with the GGCNHS angina guideline. Insulin therapy is not a contraindication to the use of B-blockers.
- ACE inhibitors should be given to patients with diabetes and any of the following: -
- post MI with or without left ventricular dysfunction;
- heart failure due to left ventricular dysfunction;
- cardiovascular, cerebrovascular or peripheral arterial disease.
- Statin therapy to reduce cholesterol should be initiated according to the NHS GGC cholesterol guidelines.
- Aspirin (75mg per day) should be given routinely and continued long term in patients with diabetes and existing cardiovascular disease in accordance with the NHS GGC guideline on anti-platelet therapy.
- Diabetic patients with worsening symptoms of angina despite medical therapy should be re-referred to cardiology in accordance with the NHS GGC angina guideline.
Myocardial Infarction and Acute Coronary Syndromes
- Patients with diabetes should be treated as all other STEMIs. +
- All should receive intensive insulin treatment for at least 24 hours following acute MI.
There is a lack of evidence for benefit from low-dose aspirin therapy in reducing cardiovascular events when used for primary prevention in people with diabetes, and evidence of harm with an increase in gastrointestinal bleeding and haemorrhagic strokes. Low-dose aspirin is not recommended for primary prevention of vascular disease in patients with diabetes.